Chap 9 Assignment

Care of Mother, Child, Adolescent (Well Clients)
1. WHAT IS NONSTRESS TEST?

A nonstress test is a common prenatal test used to check on a baby's health. During a nonstress
test, the baby's heart rate is monitored to see how it responds to the baby's movements. The term
"nonstress" refers to the fact that nothing is done to place stress on the baby during the test.
Typically, a nonstress test is recommended when it's believed that the baby is at an increased risk
of death. A nonstress test may be done after 26 to 28 weeks of pregnancy. Certain nonstress test
results might indicate that you and your baby need further monitoring, testing or special care.
A nonstress test is a noninvasive test that doesn't pose any physical risks to you or your baby.
2. INDICATIONS OF NONSTRESS TEST
A nonstress test is used to evaluate a baby's health before birth. The goal of a nonstress test is to
provide useful information about your baby's oxygen supply by checking his or her heart rate and
how it responds to your baby's movement. The test might indicate the need for further
monitoring, testing or delivery.
Normally, a baby's heart beats faster when he or she is active later in pregnancy. However,
conditions such as fetal hypoxia — when the baby doesn't get enough oxygen — can disrupt this
response.
Your health care provider might recommend a nonstress test if you have:
A multiple pregnancy with certain complications
An underlying medical condition, such as type 1 diabetes, heart disease or high blood pressure
during pregnancy
A pregnancy that has extended two weeks past your due date (post-term pregnancy)
A history of complications in a previous pregnancy
A baby who has decreased fetal movements or possible fetal growth problems
Rh (rhesus) sensitization — a potentially serious condition that can occur, typically during a
second or subsequent pregnancy, when your red cell antigen blood group is Rh negative and your
baby's blood group is Rh positive.
Low amniotic fluid (oligohydramnios)
Your health care provider might recommend having nonstress tests once or twice a week — and
occasionally daily — depending on your health and your baby's health.
3. INTERPRETATION OF NON STRESS TEST FOR: >32WEEKS -(REACTIVE
AND NONREACTIVE)
Reactive. Before week 32 of pregnancy, results are considered normal (reactive) if your baby's
heartbeat accelerates to a certain level above the baseline twice or more for at least 10 seconds
each within a 20-minute window. At week 32 of pregnancy or later, if your baby's heartbeat
accelerates to a certain level above the baseline twice or more for at least 15 seconds each within
a 20-minute window, the results are considered reactive.
Nonreactive. If your baby's heartbeat doesn't meet the criteria described above, the results are
considered nonreactive. Nonreactive results might occur because your baby was inactive or
asleep during the test.
<32WEEKS (REASSURING FOR GESTATIONAL AGE AND NOT REASSURING FOR
GESTATIONAL AGE)
The Non-Stress Test (NST) is an assessment tool used from 32 weeks of gestation to term to
evaluate fetal health through the use of electric fetal monitors that continuously record the fetal
heart rate (FHR). The test is used to determine if a fetus is at risk for intrauterine death or
neonatal complications, usually secondary to high-risk pregnancies or suspected fetal
hypoxemia. The frequency of use is based on clinical judgment, but is common because it is non-
invasive and presents a low maternal and fetal risk; however, the test does not hold predictive
value and only indicates fetal hypoxemia at time of the test.
The presence of fetal heart rate acceleration with fetal movement is the principle behind the non-
stress test. The NST recognizes the coupling of fetal neurological status to cardiovascular reflex
responses. It is one of the factors that tends to disappear earliest during progressive fetal
compromise. Interpretation of the nonstress test follows a systematic approach to include: the
baseline fetal heart rate, baseline fetal heart rate variability, presence of accelerations,
decelerations, and contractions.
Indications for the prenatal non-stress test include:
Fetal growth restriction
Diabetes mellitus, pre-gestational and gestational diabetes treated with drugs
Hypertensive disorder, chronic hypertension, and preeclampsia
Decreased fetal movement
Post-term pregnancy
Multiple pregnancies
Systemic Lupus erythematosus, Antiphospholipid antibody syndrome
Recurrent pregnancy loss
Alloimmunization, hydrops
Oligohydramnios
Cholestasis of pregnancy,
Other conditions include maternal heart diseases, hyperthyroidism, chronic liver diseases,
maternal drug abuse, and chronic renal insufficiency.
4. PROCEDURE OF NONSTRESS TEST
Before the procedure
You'll have your blood pressure taken before the nonstress test begins.
During the procedure
During the nonstress test, you'll lie on a reclining chair. You'll have your blood pressure taken at
regular intervals during the test.
Your health care provider or a member of your health care team will place a sensor around your
abdomen that measures the fetal heart rate.
Typically, a nonstress test lasts 20 minutes. However, if your baby is inactive or asleep, you
might need to extend the test for another 20 minutes — with the expectation that your baby will
become active — to ensure accurate results. Your health care provider might try to stimulate the
baby by placing a noise-making device on your abdomen.
After the procedure
After the nonstress test is complete, your health care provider will likely discuss the results with
you right away.
5. EXAMPLE OF NONSTRESS TEST WITH READING OF CONTRACTION AND

FHT
Nonstress Test
In the nonstress test, the heart rate of the fetus that is not acidotic or neurologically depressed
will temporarily accelerate with fetal movement. Heart rate reactivity is believed to be a good
indicator of normal fetal autonomic function. Loss of reactivity is commonly associated with a
fetal sleep cycle but may result from any cause of central nervous system depression, including
fetal acidosis.
Results of nonstress tests are classified as reactive or nonreactive. Various definitions of
reactivity have been used. Most commonly, the nonstress test is considered reactive, or normal, if
there are two or more fetal heart rate accelerations within a 20-minute period, with or without
fetal movement discernible by the woman, according to ACOG. The nonreactive stress test lacks
sufficient fetal heart rate accelerations over a 40-minute period. The nonstress test of the
neurologically healthy preterm fetus is frequently nonreactive—from 24 to 28 weeks of
gestation, up to 50 percent of nonstress tests may not be reactive, and from 28 to 32 weeks of
gestation, 15 percent of nonstress tests are not reactive.
Fetal Movement Assessment
Fetal movement assessment occurs when the mother perceives a diminution in fetal movement.
The mother counts fetal “kicks” as a means of antepartum fetal surveillance. The optimal number
of movements and the ideal duration for counting movements have not been determined;
however, numerous protocols have been reported and appear to be acceptable.

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Care of Mother, Child, Adolescent (Well Clients)

1. WHAT IS NONSTRESS TEST?

5. EXAMPLE OF NONSTRESS TEST WITH READING OF CONTRACTION AND

Fetal Movement Assessment

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